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Soluble transferrin receptor as an indicator of iron deficiency in HIV-infected infants
Amanda Ray1, Christopher Ndugwa, Francis Mmirot
1Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Insights
Soluble transferrin receptor (sTfR) is an adequate indicator for detecting iron deficiency in infants with HIV. This study in Uganda found sTfR effective despite common inflammation markers in HIV-infected infants.
Area of Science:
- Pediatric infectious diseases
- Nutritional deficiencies
- Biomarker research
Background:
- Iron deficiency is prevalent in HIV-infected infants in sub-Saharan Africa.
- The utility of soluble transferrin receptor (sTfR) as an iron deficiency indicator in this population is unknown.
Purpose of the Study:
- To evaluate soluble transferrin receptor (sTfR) as a diagnostic marker for iron deficiency in HIV-infected infants.
- To assess the influence of inflammation on sTfR's accuracy.
Main Methods:
- Studied 134 HIV-infected 9-month-old infants in Kampala, Uganda.
- Defined iron deficiency using low ferritin (<12 microg/L) and microcytic, hypochromic anemia.
- Assessed inflammation using C-reactive protein (>5 mg/L) and alpha1-acid glycoprotein (>1 g/L).
Main Results:
- Receiver operator characteristic curves showed areas under the curve of 0.67 (vs. low ferritin) and 0.71 (vs. anemia).
- Optimal sTfR cut-offs yielded sensitivities of 63-69% and specificities of 60%.
- Inflammation markers correlated with ferritin but not sTfR, indicating sTfR is less affected by inflammation.
Conclusions:
- Soluble transferrin receptor (sTfR) demonstrates adequate performance as an indicator of iron deficiency in HIV-infected infants.
- sTfR is a potentially reliable biomarker for iron status assessment in this vulnerable group.
Background:
Iron deficiency is common in human immunodeficiency virus (HIV)-infected infants in sub-Saharan Africa. It is not known whether soluble transferrin receptor (sTfR) is a good indicator of iron deficiency in infants with HIV.
Methods:
We evaluated sTfR as an indicator of iron deficiency in 134 HIV-infected 9-month-old infants in Kampala, Uganda. Ferritin <12 microg/L and microcytic, hypochromic anaemia were used as indicators of iron deficiency, respectively. The presence of inflammation was indicated by C-reactive protein >5 mg/L or alpha1-acid glycoprotein >1 g/L.
Results:
Receiver operator characteristic curves showed that the area under the curve was 0.67 when sTfR receptor was compared with low ferritin and 0.71 when sTfR was compared with microcytic, hypochromic anaemia. The appropriate calculated cut-offs of sTfR >3.74 microg/mL (43.98 nmol/L) and >3.53 microg/mL (41.55 nmol/L) show adequate specificities of 60% and sensitivities of 63% and 69% for low ferritin and microcytic, hypochromic anaemia, respectively. C-reactive protein and alpha 1-acid glycoprotein were strongly correlated with serum ferritin (r=0.371 and r=0.458, respectively, both p<0.0001) but were not correlated with sTfR (r=0.009 and r= -0.003, respectively, both p=0.9). In all, 78.6% of infants had alpha l-acid glycoprotein >1 g/L and 54.7% had C-reactive protein >5 g/L.
Conclusions:
Soluble TfR appears to be an adequate indicator of iron deficiency in HIV-infected infants.
